Management of Menopausal Symptoms.
Management of Menopausal Symptoms.
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DOI：
10.1097/aog.0000000000001058
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发表时间：
2015-10
影响因子：
7.2
通讯作者：
Manson JE
中科院分区：
文献类型：
--
作者：
Kaunitz AM;Manson JE
大多数绝经期妇女都有血管舒缩症状，令人烦恼的症状通常持续超过十年。激素治疗（HT）是对这些症状最有效的治疗方法，口服和透皮雌激素制剂具有相当的疗效。来自妇女健康倡议和其他近期随机临床试验的发现有助于阐明雌激素-黄体酮联合治疗和雌激素单独治疗的益处和风险。观察到的HT的绝对风险往往很小，尤其是在年轻女性中。两种方案都没有影响全因死亡率。考虑到接近绝经期妇女的激素治疗不良事件发生率较低，心血管疾病基线风险较低，风险分层和个性化风险评估似乎是优化激素治疗获益、风险概况和安全性的一种合理策略。系统性HT不应在65岁时任意停止；相反，治疗时间应该根据患者的风险概况和个人偏好进行个体化。绝经期泌尿生殖系统综合征是一种常见的疾病，对许多绝经期妇女的生活质量产生不利影响。如果不治疗，症状会随着时间的推移而恶化。低剂量阴道雌激素是治疗此病的有效方法。由于定制合成激素的有效性和安全性尚未经过测试，美国食品和药物管理局（FDA）批准的激素是首选。甲磺酸帕罗西汀的低剂量制剂目前是fda批准治疗血管舒缩症状的唯一非激素药物。妇科医生和其他临床医生及时了解有关激素和非激素治疗的益处和风险概况的数据，可以帮助更年期妇女在处理更年期症状方面做出合理的选择。
Most menopausal women experience vasomotor symptoms, with bothersome symptoms often lasting longer than one decade. Hormone therapy (HT) represents the most effective treatment for these symptoms, with oral and transdermal estrogen formulations having comparable efficacy. Findings from the Women’s Health Initiative and other recent randomized clinical trials have helped to clarify the benefits and risks of combination estrogen-progestin and estrogen-alone therapy. Absolute risks observed with HT tended to be small, especially in younger women. Neither regimen affected all-cause mortality rates. Given the lower rates of adverse events on HT among women close to menopause onset and at lower baseline risk of cardiovascular disease, risk stratification and personalized risk assessment appears to represent a sound strategy for optimizing the benefit: risk profile and safety of hormone therapy. Systemic HT should not be arbitrarily stopped at age 65; instead treatment duration should be individualized based on patients’ risk profiles and personal preferences. Genitourinary syndrome of menopause represents a common condition that adversely impacts the quality of life of many menopausal women. Without treatment, symptoms worsen over time. Low-dose vaginal estrogen represents highly effective treatment for this condition. Because custom-compounded hormones have not been tested for efficacy or safety, U.S. Food and Drug Administration (FDA)-approved HT is preferred. A low dose formulation of paroxetine mesylate currently represents the only nonhormonal medication FDA-approved to treat vasomotor symptoms. Gynecologists and other clinicians who remain abreast of data addressing the benefit: risk profile of hormonal and nonhormonal treatments can help menopausal women make sound choices regarding management of menopausal symptoms.